Provider Demographics
NPI:1386190734
Name:BRAIN SPINE AND SLEEP INSTITUTE LLC
Entity Type:Organization
Organization Name:BRAIN SPINE AND SLEEP INSTITUTE LLC
Other - Org Name:BRAIN SPINE AND SLEEP INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOUSLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-676-6386
Mailing Address - Street 1:1120 CARLTON AVE
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4347
Mailing Address - Country:US
Mailing Address - Phone:863-676-6386
Mailing Address - Fax:863-676-3124
Practice Address - Street 1:1120 CARLTON AVE
Practice Address - Street 2:SUITE 1300
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4347
Practice Address - Country:US
Practice Address - Phone:863-676-6386
Practice Address - Fax:863-676-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME97722OtherLICENSE
FLME97722OtherLICENSE